20041058.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME j
ADDRESS
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CITY ZIP TELEPHONE
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NAME
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ADDRESS
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CITY ZIP
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION
fill 'Ell � I ti3bNA 117,113169
DATE
PROPERTY TAX ACCOUNT PARCEL NO.
COY50 CA ??0000
NEW RESIDENTIAL
Fi
PLUMBING I MECH
ADDITION COMMERCIAL
F
COMPLIANCE OR
CHANGE OF USE
REMODEL 11 MULTIFAMILY
SIGN
E] REPAIR E] GRADING
CYDS
FENCE
( x FT)
DEMOLISH TANK
Win rixor,
GARAGE o RETAINING WALL
CARPORT ROCKERY
E:]
FIRE SPRINKLER
FIRE ALARM
[TYPE gE USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STi UNITS NUMBER
DESCRIBE fiORK TO BE DONE
171vio-diAlf—C�_ CIA -)I IRWrIC) CUt?0 UAP-11
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PLAN CHECK NO' I VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
ul PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF TAIE STATE OF WASHINGTON RELATING TO
WORKMEN'S 061�NSATION INFtURANCE 44D RCW
DATE
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ADDRESS;?
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES W
PERMIT
NUMBER
SUITE/APT#
q sill LIU
I LOT NO. LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED -
REQUIRED DEDICATION- FT -
METER SIZE I LINE SIZE I NO. OF FIX'
LID FEE $
TESCP Approved Ei
RW Permit Required E3
Street Use Permit Roq'd 13
Inspection Required
d
Sidewalk Require E3
Underground
wiring required E3
LIRES PRV REQUIRED
YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
T_ Al ��'yr in e2; 12-13
REVIEWED BY DATE
VARIANCE OR CU
HORELINE OR ADB#
INSPECTION
I BOND
REO'D ,
I
I POSTED
OYES
2'NO
IS
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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0
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EXP
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT QRSIDE REAR
35) "� 2.4 V*
26 75- W
9-1,5 75
PARKING
LOT AREAAJ
PLANNING REVIEWED BY DATE
REO'D I PROVIDED
2, 7, - I
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11-/ '7A_4+
REMARKS
CHECKED BY JTYP��CTION OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA 3ao q7 OCCUPANT
REQUIRED [] YES LOAD
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REMARKS 0
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PROGRESS INSPECTIONS PER UBC 108/IeC109/IRC109 FINAL INSPECTION REO'D I �
VALUATION
$ Z:�l It
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description
State Surcharge
City Surcharge
Base Fee
0
(425)
771-0220
ATTENTION I � E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE
2—
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # 4(7
APPEICATION APPROVA I I
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged III space provided.
ICIA1 B SIGNATUR DAT
:L�ASE� BYJ DAT
I
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
1716
YELLOW - INSPEGTO
GOLD -ASSESSOR
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Date:
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MEMO TO:
FINAL PROJECT APPROVAL FORM
PERMIT COORDINATOR, BUILDING DIVISION
TO:
DATE:
FROM: FIRE DEPARTMENT DATE
PLEASE SIGN
J--Z') 2z , A�IULJ�A�ENGINEERING DIVISION DATE,
PLEASES
PLANNING DIVISION DATE
PROJECT Diz jl,��J-
SITE ADDRESS V ef
PERmrr#Z2jj4y__-/(0.�5 _ADB# DATE INSPECTED 3/30 A0 5-
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
a Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing r4 7�
05
Mo
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Wall..........................
Pier/Porch
MIT -
.................
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Retaining Wall ...........
lk
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
,e '.
'riic Initials NIT are Milton
Thompson, I temporary contract
inspector ror tile City.
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